You are here

Imagine that!

As for other states like Florida, Texas and Louisiana, consider the following attack ad, modelled on Mark Totten's press release above:

"Tens of thousands of Louisianans will have to pay hundreds of dollars in higher taxes...all because Bobby Jindal is too petty to shell out $10 bucks for a domain name!!"

The Republicans in two dozen states thought they were playing smart politics (with people's lives, but screw them, right?) when they denied Medicaid expansion, but this has since blown up in their faces, and has now become a potent issue for Democrats in several GOP-held states. I think I know why they thought this...and why it didn't work out the way they figured.

As far as I can tell, the Republican mindset was this: Poor people don't vote. Therefore, screwing over poor people = brownie points from the GOP base without any potential downside.

However, I think they forgot something important: Regular Medicaid might only apply to poor people, but the Medicaid expansion provided for by the ACA applies to many lower-middle class people...and they do vote (at least in far greater numbers than the "dirt poor" anyway).

In this case, the potential backfire is even greater, for two reasons.

First, when those states denied Medicaid expansion, they were denying those 5 million people something which didn't exist yet. With the tax subsidies, you're yanking away cold hard cash from millions of people who already are receiving it. That's a huge difference. It's one thing to be promised something and then have that promise recalled; it's something else to actually have something in hand and then be told that you have to give it back. Ask people how they'd feel about expanding Medicare vs. having their existing Medicare taken away and you'll see my point.

Secondly, I don't know the exact voting patterns of different socioeconomic levels, but I have to imagine that most of the people receiving ACA subsidies are even more likely to be active voters than those who were screwed out of Medicaid a few rungs down the econimic ladder.

Translation: Chemotherapy turned off for perhaps 12,000 people, dialysis going dark for 10,000. The horror stories will be real.

What will happen next is predictable: A deluge of attacks on Republicans for supposedly having caused this. Daily White House emergency briefings. Liberal interest-group ads of wheelchairs going over cliffs. President Obama’s cheerleaders in the media screaming that ideologues are killing patients.

When Team Obama then turns its guns on the holdout states and their 37 governors, the political pressure to adopt ObamaCare will be crippling. I fear that most governors will fold. We’ve already seen some Republican governors finesse their principles to expand Medicaid and secure extra money. The new pressure will be even more acute.

Officials in several Republican states that balked at participating in President Obama’s ­health-care initiative are now revisiting the issue amid mounting panic over a possible Supreme Court decision that would revoke federal insurance subsidies for millions of Americans.

The discussions taking place in state capitals around the country are part of a flurry of planning and lobbying by officials, insurance and hospital executives, and health-care advocates to blunt the possible impact of a court ruling.

The justices hear arguments about the matter next week. If the court sides with the plaintiffs, who argue that subsidies are not allowed in the 34 states that opted against setting up their own insurance marketplaces, the ruling could spark an immediate crisis. People could see their insurance bills skyrocket and be forced to abruptly cancel their coverage.

At least six states where ­Republican leaders had previously refused to set up state marketplaces under the Affordable Care Act are now considering what steps they might take to preserve the subsidies being paid to their residents.

Efforts to hold on to the subsidies are under consideration even in South Carolina, which supported the challenge now ­before the Supreme Court. Gov. Nikki Haley (R) said in an interview that South Carolina may consider setting up a marketplace, though it is unclear how such a proposal would fare in the staunchly conservative state.

...Among the other Republican-led states where officials are now looking at options for engaging with the ACA health-care ­program are Maine, South Dakota and Utah, as well as South Carolina. Pennsylvania’s newly minted Gov. Tom Wolf (D) has said he supports going forward with a state exchange, a shift from the position of his Republican predecessor.